Healthcare Provider Details

I. General information

NPI: 1114792074
Provider Name (Legal Business Name): LEYDEN FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MANNHEIM RD
FRANKLIN PARK IL
60131-3137
US

IV. Provider business mailing address

2600 MANNHEIM RD
FRANKLIN PARK IL
60131-3137
US

V. Phone/Fax

Practice location:
  • Phone: 847-455-0180
  • Fax:
Mailing address:
  • Phone: 847-455-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENDA KAY FARLOW
Title or Position: FIRE CHIEF
Credential:
Phone: 847-455-0180